Safe use of pegylated interferon/ribavirin in hepatitis C virus cirrhotic patients with hypersplenism after partial splenic embolization

Foruny, José Ramón; Blázquez, Javier; Moreno, Ana; Bárcena, Rafael; Gil-Grande, L; Quereda, Carmen; Pérez-Elías, María Jesús; Moreno, Javier; Sánchez, Juan; Muriel, Alfonso; Rodríguez-Sagrado, Miguel Ángel; Moreno, Santiago

doi:10.1097/00042737-200511000-00002

Cited by 45 publications

(54 citation statements)

References 34 publications

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“…All 30 patients were able to receive therapy with pegylated interferon and ribavirin following a PSE-related increase in their platelet counts. A handful of other studies have demonstrated similar findings over the past decade [21][22][23] . Similar to the use of PSE to improve platelet counts prior to antiviral therapy in patients with hepatitis C, PSE has been used to increase hematologic indices to facilitate treatment of hepatocellular carcinoma.…”

Section: Complications Of Psesupporting

confidence: 64%

Partial splenic artery embolization in cirrhotic patients

Hadduck¹,

McWilliams²

2014

WJR

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Splenomegaly is a common sequela of cirrhosis, and is frequently associated with decreased hematologic indices including thrombocytopenia and leukopenia. Partial splenic artery embolization (PSE) has been demonstrated to effectively increase hematologic indices in cirrhotic patients with splenomegaly. This is particularly valuable amongst those cirrhotic patients who are not viable candidates for splenectomy. Although PSE was originally developed decades ago, it has recently received increased attention. Presently, PSE is being utilized to address a number of clinical concerns in the setting of cirrhosis, including: decreased hematologic indices, portal hypertension and its associated sequela, and splenic artery steal syndrome. Following PSE patients demonstrate significant increases in platelets and leukocytes. Though progressive decline of hematologic indices occur following PSE, they remain improved as compared to pre-procedural values over long-term follow-up. PSE, however, is not without risk and complications of the procedure may occur. The most common complication of PSE is post-embolization syndrome, which involves a constellation of symptoms including fever, pain, and nausea/vomiting. The rate of complications has been shown to increase as the percent of total splenic volume embolized increases. The purpose of this review is to explore the current literature in regards to PSE in cirrhotic patients and to highlight their techniques, and statistically summarize their results and associated complications. Key words: Partial splenic embolization; Cirrhosis; Liver disease; Thrombocytopenia; Leukopenia Core tip: Splenomegaly is a common sequela of cirrhosis, and is frequently associated with decreased hematologic indices including thrombocytopenia and leukopenia. Partial splenic artery embolization (PSE) has been demonstrated to effectively increase hematologic indices in cirrhotic patients with splenomegaly. This is particularly valuable amongst cirrhotic patients that are not viable candidates for splenectomy. Although PSE was originally developed decades ago, it has recently received increased attention. Presently, PSE is being utilized to address a number of clinical concerns in the setting of cirrhosis, including: decreased hematologic indices, portal hypertension and its associated sequela, and splenic artery steal syndrome.Hadduck TA, McWilliams JP. Partial splenic artery embolization in cirrhotic patients. World J Radiol 2014; 6(5): 160-168 Available from:

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Section: Complications Of Psesupporting

confidence: 64%

Partial splenic artery embolization in cirrhotic patients

Hadduck¹,

McWilliams²

2014

WJR

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Section: Discussionmentioning

confidence: 99%

“…To date, several papers on the efficacy of PSE prior to starting interferon therapy have been already reported (12)(13)(14)(15)(16). First, Moreno et al (12,13) reported the usefulness of PSE prior to starting the combined therapy with peginterferon and ribavirin in HCV cirrhotic patients with thrombocytopenia; however, their reports were one-arm studies and did not have a non-PSE group. Furthermore, although the currently recommended therapy of chronic HCV infection is the combination of peginterferon and ribavirin (5), the study population of other 2 reports mainly consisted of patients treated with conventional interferon or consensus interferon (14,15).…”

Section: Discussionmentioning

confidence: 99%

Partial Splenic Embolization Facilitates the Adherence to Peginterferon in Chronic Hepatitis C with Thrombocytopenia

et al. 2011

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Objective Platelet counts before starting the treatment affect the discontinuation and dose reduction of peginterferon in chronic hepatitis C. Thrombocytopenia leads to failure to achieve sustained virological response. This study was undertaken to evaluate the efficacy of partial splenic embolization (PSE) prior to starting peginterferon therapy combined with ribavirin in chronic hepatitis C patients showing thrombocytopenia. Patients and MethodsWe compared the clinical features of 11 patients receiving PSE (PSE group) prior to starting the combined therapy with those of 13 patients not receiving PSE (non-PSE group). All of the patients showed platelet counts !12×10 4 /mm 3 and serum hepatitis C virus-RNA levels "100 KIU/mL at baseline. The end-point of PSE was a volume of splenic infarction over 75%. Peginterferon alpha-2b at a dose of 1.2 μg/kg was administered by subcutaneous injection once a week. The dose of ribavirin was weight adjusted. Results PSE was successfully performed without serious adverse events. The period from PSE to starting the combined therapy was 14 (6-27) days. After PSE, platelet counts were significantly increased. In PSE group, platelet counts during the combined therapy were maintained above those at baseline. In non-PSE group, platelet counts at the 2nd week after the start of the combined therapy significantly decreased to less than those at baseline. Overall, 80% adherence to expected peginterferon dose was not achieved in 5 patients (45%) of PSE group and in 11 (85%) of non-PSE group (p=0.043). Conclusion Increased platelet counts after PSE facilitates the adherence to peginterferon therapy in chronic hepatitis C patients with thrombocytopenia.

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“…Hypersplenism can be corrected by laparoscopic splenectomy or partial splenic embolization. 11 But these procedures are associated with morbidity such as portal vein thrombosis, infection, or worsening of liver function. Besides, the rise of platelets after partial splenic embolization may only be shortlived.…”

Section: Strategies To Boost Platelet Count In Hepatitis C Patientsmentioning

confidence: 99%

Correcting thrombocytopenia in patients with liver diseases: A difficult hurdle

Wai

2013

J of Gastro and Hepatol

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Safe use of pegylated interferon/ribavirin in hepatitis C virus cirrhotic patients with hypersplenism after partial splenic embolization

Abstract: PSE allowed the safe use of peg-IFN plus ribavirin in HCV cirrhotic patients with severe cytopenias who otherwise would never have been treated. The rate of SVR was 38%.

Cited by 45 publications

References 34 publications

Partial splenic artery embolization in cirrhotic patients

Partial splenic artery embolization in cirrhotic patients

Partial Splenic Embolization Facilitates the Adherence to Peginterferon in Chronic Hepatitis C with Thrombocytopenia

Correcting thrombocytopenia in patients with liver diseases: A difficult hurdle

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